How to spot an ear infection in your baby
Babies cannot tell you their ears hurt, so you have to watch for signs. The most common ones are pulling or tugging at the ear, fever, fussiness or crying that is worse than usual, trouble sleeping, and fluid or pus draining from the ear. Some babies also lose their appetite or vomit. Not every baby shows all these signs — some have only one or two.
Ear infections are common in babies and young children because their ear tubes are shorter and more horizontal than an adult's, which makes it easier for fluid to get trapped. If your baby shows any of these signs, especially if they also have a cold or upper respiratory infection, it is worth calling your pediatrician.
Key Takeaways
- Pulling at the ear, fever, and unusual fussiness are the most common signs of an ear infection in babies.
- Babies under six months with a fever should be seen by a doctor right away, even if you are not sure it is an ear infection.
- A doctor uses an otoscope — a small lighted tool — to look inside the ear and confirm whether fluid or infection is present.
- Many ear infections clear on their own within a few days, but your doctor will tell you whether your baby needs antibiotics.
- Fluid in the ear can persist for weeks after the infection clears, which is normal and usually does not need treatment.
What pulling at the ear really means
Babies pull at their ears for many reasons — teething, tiredness, or just exploring their own body. But when ear pulling happens along with other signs like fever, fussiness, or a recent cold, it becomes more suspicious for infection.
The key is looking at the whole picture, not one sign alone. A baby who is pulling at one ear, running a fever, and has been sick for a few days is more likely to have an infection than a baby who pulls at their ears once while playing and is otherwise happy and eating normally.
Fever and other physical signs
A fever of 100.4°F (38°C) or higher in a baby under three months is always a reason to call a doctor, whether or not you think it is an ear infection. Babies this young can become seriously ill quickly, and a fever is a sign that something needs to be checked.
For babies older than three months, a fever with other signs — like ear pulling, fussiness, or drainage from the ear — points more strongly toward an infection. Drainage from the ear is one of the clearest signs, because it means fluid or pus has built up enough to leak out. If you see fluid coming from your baby's ear, contact your pediatrician.
Some babies with ear infections have no fever at all. They may just be fussy, sleeping poorly, or eating less than usual. This is why your doctor cannot diagnose an ear infection by symptoms alone.
How a doctor checks for an ear infection
Your pediatrician will use a tool called an otoscope — a small handheld device with a light and a magnifying lens — to look inside your baby's ear. This is painless and takes only a few seconds. The doctor is looking for redness, fluid behind the eardrum, or pus, all of which point to infection.
Sometimes the doctor will also use a tool called a pneumatic otoscope, which gently puffs air into the ear to see whether the eardrum moves normally. If fluid is trapped behind the eardrum, it will not move as much. This test is also painless.
In some cases, especially if the diagnosis is unclear or if your baby has had many infections, the doctor may recommend a test called tympanometry, which measures how the eardrum responds to sound and pressure. This is also painless and takes less than a minute.
What happens after diagnosis
If your doctor confirms an ear infection, the next step depends on your baby's age and how severe the infection is. Many ear infections in babies older than six months clear on their own within a few days without antibiotics. Your doctor may recommend pain relief — usually acetaminophen or ibuprofen — and watching to see if your baby improves.
Babies under six months, or babies with severe symptoms, are more likely to be given antibiotics. If antibiotics are prescribed, it is important to give the full course even if your baby seems better after a few days. Stopping early can allow the infection to come back.
Your doctor will usually want to see your baby again one to two weeks after diagnosis to make sure the infection has cleared. Even after the infection is gone, fluid can remain in the ear for weeks or months — this is normal and usually does not need treatment unless it affects your baby's hearing.
When to call the doctor right away
Call your pediatrician immediately if your baby has a fever and is under three months old, regardless of other symptoms. Also call right away if your baby has severe pain, is vomiting repeatedly, has fluid draining from the ear, or seems unusually sleepy or unresponsive.
If your baby was diagnosed with an ear infection and is on antibiotics but is not improving after two or three days, or if symptoms get worse, contact your doctor. Some infections are caused by bacteria that do not respond to the first antibiotic chosen, and your doctor may need to switch medications.
Reducing the risk of ear infections
You cannot prevent all ear infections, but some things lower the risk. Breastfeeding, especially for the first six months, offers protection because breast milk contains antibodies. Keeping your baby away from secondhand smoke and avoiding bottle-feeding while your baby is lying flat also help.
Keeping your baby's vaccinations current — including the pneumococcal and flu vaccines — reduces the risk of infections that can lead to ear problems. Washing hands frequently and keeping your baby away from sick people during cold and flu season also matters, especially during the first year of life.
Frequently Asked Questions
Can I treat an ear infection at home without seeing a doctor?
No. Only a doctor can confirm whether your baby has an ear infection by looking in the ear with an otoscope. Pain relief at home may make your baby more comfortable, but it does not treat the infection itself. If your baby shows signs of infection, contact your pediatrician.
How long does it take for an ear infection to go away?
Many ear infections clear within a few days to a week, even without antibiotics. If antibiotics are prescribed, symptoms usually improve within 24 to 48 hours, but the full course should be completed. Some babies have fluid in the ear for weeks after the infection clears, which is normal.
Can teething cause an ear infection?
Teething does not cause ear infections, but it can cause babies to pull at their ears. If your teething baby also has a fever, fussiness that is worse than usual, or drainage from the ear, contact your doctor to rule out infection.
Is it normal for babies to get ear infections over and over?
Repeated ear infections are common in babies and young children, especially between ages six months and three years. If your baby has more than four infections in six months or more than six in a year, talk to your doctor about whether further evaluation is needed.
Will an ear infection affect my baby's hearing?
A single ear infection usually does not cause permanent hearing loss. However, fluid in the ear can temporarily muffle sound. If your baby has many infections or fluid that lasts more than three months, your doctor may test hearing to make sure development is on track.